If you offer a group health plan, it’s imperative to properly administer all of the health plan notices required. Otherwise, you could face costly penalties.
Here is a rundown of the notices you might wish to include in your open enrollment communication efforts:
Summary Plan Description (SPD)
This document must include specific information about what the health plan covers, how it operates, how employees can take advantage of their benefits once they’ve enrolled, how they can file a claim, and finally, the process for appealing denied benefits.
Summary of Benefits and Coverage (SBC) and Uniform Glossary
Your SBC is a standardized, four-page document that contains a short description of all of your benefits in plain language that is easy for anyone to understand.
Summary of Material Modifications (SMM) and Notice of Modification
An SMM must be provided to every plan participant covered under the plan when “material modifications” have been made to that plan other than at the time of renewal.
The CHIPRA (Children’s Health Insurance Program Reauthorization Act) notice informs employees of potential opportunities for group health plan premium assistance opportunities through Medicaid and the Children’s Health Insurance Program (CHIP).
HIPAA Special Enrollment Rights Notice
HIPAA (The Health Insurance Portability and Accountability Act) offers eligible employees additional opportunities to enroll in a group health plan if they lose other coverage or experience certain life events, commonly referred to as Qualifying Life Events (QLEs).
HIPAA Privacy Notice
HIPAA’s Privacy Notice describes, in detail, how medical information about an employee or covered dependent may be used and disclosed, and how the covered plan participant can get access to that information.
Availability of Health Insurance Marketplaces Notice
Under the PPACA, employers covered by the Fair Labor Standards Act (FLSA) are required to provide a notice to employees about the health insurance marketplace/exchanges of the state(s) in which they operate.
The law requires that each plan participant (and any covered spouse) be notified of their COBRA (Consolidated Omnibus Reconciliation Act) rights when coverage under any health plan begins (this is referred to as the initial COBRA notice).
Medicare Part D Creditable (or Non-Creditable) Coverage Notice
This annual notice must be provided to any participant (employee or dependent) who has coverage under Medicare Part A or coverage under Medicare Part B and who lives in the service area of a Medicare Part D prescription drug plan.
Grandfathered Plan Status Notice
This disclosure must state if a plan is “grandfathered.” For example, plans in effect before the enactment of the PPACA are exempt from some of the insurance market reforms under the ACA.
Internal Claims and Appeals and External Reviews Notice
The Patient Protection and Affordable Care Act (ACA) requires group health plans and health insurers to implement an “effective” process for appeals of coverage determinations and claims, including an internal claims appeal process and employee notification.
Women’s Health & Cancer Rights Act of 1998 Notice
The WHCRA (Women’s Health and Cancer Rights Act of 1998) requires group health plans to make certain benefits available to participants who have undergone a mastectomy.
Always Check With an Attorney
Before sending out any relevant benefit documents, be sure to take the time to have them reviewed by an attorney, to ensure that they are compliant and contain all necessary information.